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Wellbeing-enhancing occupation and organizational and environmental contributors in long-term dementia care facilities: an explorative study

  • Dieneke Smit (a1), Bernadette Willemse (a1) (a2), Jacomine de Lange (a2) and Anne Margriet Pot (a1) (a2)



Occupation remains an unmet need in long-term dementia care. To increase residents’ occupation, knowledge of types of occupation related to wellbeing, and organizational and environmental characteristics encouraging involvement in these types of occupation, is indispensable.


In this explorative study, Dementia Care Mapping was used to study involvement in different types of occupation and wellbeing among 57 residents of 10 dementia care facilities. For each type of occupation, mean experienced wellbeing was studied. Occupation types with high mean wellbeing scores were classified as “wellbeing-enhancing occupation.” Care facilities were ranked according to the mean time residents spent in types of wellbeing-enhancing occupation. Using information on staff-to-resident ratio, individual space, and items of the Physical Environment Evaluation Component of Dementia Care Mapping, organizational and environmental characteristics of the facilities were compared to study their relationship with wellbeing-enhancing occupation.


Reminiscence, leisure, expression, and vocational occupation had greatest potential to enhance wellbeing, but these types were seldom offered. Much variation existed in the extent to which wellbeing-enhancing occupation was provided. Long-term care facilities that did so more frequently generally had a more homelike atmosphere, supported social interaction through the environment, and had no central activity program.


This study suggests that it is possible to engage residents in wellbeing-enhancing occupation, within current means of budget and staff. The physical environment and care organization might play a role, but the key factor seems to equip staff with skills to integrate wellbeing-enhancing occupation into care practice.


Corresponding author

Correspondence should be addressed to: Dieneke Smit, Trimbos-instituut, PO Box 725, 3500 AS Utrecht, the Netherlands. Phone: +31 (0)61-4123943. Email:


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American Psychiatric Association (2007). American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. Second edition. American Journal of Psychiatry, 164, 556. doi:10.1176/appi.books.9780890423967.152139
Bradford Dementia Group (2005). DCM 8 User's Manual. Bradford: University of Bradford.
Brooker, D. (2005). Dementia Care Mapping: a review of the research literature. The Gerontologist, 45, 1118.
Brooker, D. and Surr, C. (2006). Dementia Care Mapping (DCM): initial validation of DCM8 in UK field trials. International Journal of Geriatric Psychiatry, 21, 10181025. doi:10.1002/gps.1600
Brooker, D. J., Wooley, R. J. and Lee, D. (2007). Enriching opportunities for people living with dementia in nursing homes: an evaluation of a multi-level activity based model of care. Aging and Mental Health, 11, 361370. doi:10.1080/13607860600963679
Cohen-Mansfield, J., Thein, K., Dakheel-Ali, M. and Marx, M. S. (2010a). The underlying meaning of stimuli: impact on engagement of persons with dementia. Psychiatry Research, 177, 216222. doi:10.1016/j.psychres.2009.02.010
Cohen-Mansfield, J., Thein, K., Dakheel-Ali, M. and Marx, M. S. (2010b). Engaging nursing home residents with dementia in activities: the effects of modeling, presentation order, time of day and setting characteristics. Aging and Mental Health, 14, 471480. doi:10.1080/1360780903586102
Chaudhury, H., Cooke, H. and Frazee, K. (2013). Developing a physical environmental evaluation component of the Dementia Care Mapping (DCM) Tool. In Rowles, G. and Bernard, M. (eds.), Environmental Gerontology: Making Meaningful Places in Old Age. New York: Springer.
Cook, C., Fay, S. and Rockwood, K. (2008). Decreased initiation of usual activities in people with mild-to-moderate Alzheimer's disease: a descriptive analysis from the VISTA clinical trial. International Psychogeriatrics, 20, 952963. doi:10.1017/S1041610208007230
Dobbs, D., Munn, J., Zimmerman, S., Boustani, M., Williams, C. S., Sloane, P. D. and Reed, P. S. (2005). Characteristics associated with lower activity involvement in long-term care residents with dementia. The Gerontologist, 45 (Suppl. 1), 8186. doi:10.1093/geront/45.suppl_1.81
Dröes, R. al. (2006). Quality of life in dementia in perspective. An explorative study of variations in opinions among people with dementia and their professional caregivers, and in literature. Dementia, 5, 533558. doi:10.1177/1471301206069929
Elliot, G. M. (2011). Montessori Methods for Dementia: Focusing on the Person and the Prepared Environment. Hamilton, Ontario, Canada: McMaster University.
Ettema, T. P., Dröes, R. M., de Lange, J., Mellenbergh, G. J. and Ribbe, M. W. (2007). QUALIDEM: development and evaluation of a dementia specific quality of life instrument – validation. International Journal of Geriatric Psychiatry, 22, 424430. doi:10.1002/gps.1692
Fossey, J., Lee, L. and Ballard, C. (2002). Dementia Care Mapping as a research tool for measuring quality of life in care settings: psychometric properties. International Journal of Geriatric Psychiatry, 17, 10641070. doi:10.1002/gps.708
Fritsch, T., Kwak, J., Grant, S., Lang, J., Montgomery, R. R. and Basting, A. D. (2009). Impact of TimeSlips, a creative expression intervention program, on nursing home residents with dementia and their caregivers. The Gerontologist, 49, 117127. doi:10.1093/geront/gnp008.
Harmer, B. J. and Orrell, M. (2008). What is meaningful activity for people with dementia living in care homes? A comparison of the views of older people with dementia, staff and family carers. Aging and Mental Health, 12, 548558. doi:10.1080/1360786080234019
Innes, A. and Surr, C. (2001). Measuring the well-being of people with dementia living in formal care settings: the use of Dementia Care Mapping. Aging and Mental Health, 5, 258268. doi:10.1080/13607860120065023
interRAI (2005). Resident Assessment Instrument. interRAI LTC. Available at
Kitwood, T. (1997). Dementia Reconsidered, the Person Comes First. Buckingham: Open University Press.
Kolanowski, A., Buettner, L., Litaker, M. and Yu, F. (2006). Factors that relate to activity engagement in nursing home residents. American Journal of Alzheimer's Disease and Other Dementias, 21, 1522. doi:10.1177/153331750602100109
Knight, T. and Mellor, D. (2007). Social inclusion for older adults in care: is it just a question of providing activities? International Journal of Qualitative Studies on Health and Well-being, 2, 7685.
Kuhn, D., Fulton, B. R. and Edelman, P. (2004). Factors influencing participation in activities in dementia care settings. Alzheimer's Care Quarterly, 5, 144152.
Lintern, T., Woods, B. and Phair, L. (2000). Before and after training: a case study of interventions. Journal of Dementia Care, 8, 1517.
Maslach, C. and Jackson, S. E. (1986). MBI: Maslach Burnout Inventory: Manual Research Edition, 2nd edn. Palo Alto, CA: Consulting Psychologists Press.
National Collaborating Centre for Mental Health (2007). Dementia. A NICE-SCIE Guideline on Supporting People with Dementia and Their Carers in Health and Social Care. Leicester and London: The British Psychological Society and The Royal College of Psychiatrists.
Orrell, M., Hancock, G. A., Galboda Liyanage, K. C., Woods, B., Challis, D. and Hoe, J. (2008). The needs of people with dementia in care homes: the perspectives of users, staff and family caregivers. International Psychogeriatrics, 20, 941951. doi:10.1017/S1041610208007266
Passos, J., Sequeira, C. and Fernandes, L. (2012). The needs of older people with mental health problems: a particular focus on dementia patients and their carers. International Journal of Alzheimer's Disease, article ID 638267. doi:10.1155/2012/638267
Perrin, T., May, H. and Anderson, E. (2008). Wellbeing in Dementia, an Occupational Approach for Therapists and Carers, 2nd edn. Edinburgh: Churchill Livingstone Elsevier.
Phinney, A., Chaudhury, H. and O'connor, D. L. (2007). Doing as much as I can do: the meaning of activity for people with dementia. Aging and Mental Health, 11, 384393. doi:10.1080/1360786061086470
Schreiner, A. S., Yamamote, E. and Shiotani, H. (2005). Positive affect among nursing home residents with Alzheimer's dementia: the effect of recreational activity. Aging and Mental Health, 9, 129134. doi:10.1080/13607860412331336841
Scottish Intercollegiate Guidelines Network (2006). Management of Patients with Dementia. A National Clinical Guideline. Edinburgh: Scottish Intercollegiate Guidelines Network.
Sloane, P. al. (2002). The therapeutic environment screening survey for nursing homes (TESS-NH): an observational instrument for assessing the physical environment for institutional settings for persons with dementia. Journal of Gerontology: Social Sciences, 57B, S69–S78. doi:10.1093/geronb/57.2.S69
Sloane, Ph. al. (2007). Dementia Care Mapping as a research tool. International Journal of Geriatric Psychiatry, 22, 580589. doi:10.1002/gps.1721
Smit, D., de Lange, J., Willemse, B. and Pot, A. M. (2012). The relationship between small-scale care and activity involvement of residents with dementia. International Psychogeriatrics, 24, 722732. doi:10.1017/S1041610211002377
Smith, R., Mathews, R. M. and Gresham, M. (2010). Pre- and postoccupancy evaluation of new dementia care cottages. American Journal of Alzheimer's Disease and Other Dementias, 25, 265275. doi:10.1177/1533317509357735
Train, G. H., Nurock, S. A., Manela, M., Kitchen, G. and Livingston, G. A. (2005). A qualitative study of the experiences of long-term care for residents with dementia, their relatives and staff. Aging and Mental Health, 9, 119128. doi:10.1080/13607860412331310236
van der Doef, M. and Maes, S. (1999). The Leiden quality of work questionnaire: its construction, factor structure, and psychometric qualities. Psychological Reports, 85, 954962.
Vollicer, L., Simard, J., Heartquist Pupa, J., Medrek, R. and Riordan, M. E. (2006). Effects of continuous activity programming on behavioral symptoms of dementia. Journal of the American Medical Directors Association, 7, 426431. doi:10.1016/j.jamda.2006.02.003
Willemse, B., Smit, D., De Lange, J. and Pot, A. M. (2011). Nursing home care for people with dementia and residents’ quality of life, quality of care and staff well-being: design of the living arrangements for people with dementia (LAD) – study. BMC Geriatrics, 11, 11. doi:10.1186/1471-2318-11-11
Williams, C. L. and Tappen, R. M. (2007). Effect of exercise on mood in nursing home residents with Alzheimer's disease. American Journal of Alzheimer's Disease and Other Dementias, 22, 389397. doi:10.1177/1533317507305588
Wood, W., Harris, S., Snider, M. and Patchel, S. A. (2005). Activity situations on an Alzheimer's disease special care unit and resident environmental interaction, time use, and affect. American Journal of Alzheimer's Disease and Other Dementias, 20, 105118. doi:10.1177/153331750502000210



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